title: Safety of IV thrombolysis in acute ischemic stroke related to Chagas disease.
abstract: OBJECTIVE
  To determine the rate of symptomatic intracranial hemorrhage (SIH) and in-hospital mortality among patients with acute ischemic stroke related to Chagas disease (CD) treated with IV tissue plasminogen activator (TPA).
  
  
  METHODS
  In this retrospective cohort study, consecutive stroke patients treated with IV TPA and routinely tested for CD were retrospectively selected from a single-center, hospital-based, prospective registry of acute stroke patients from 2001 to 2012. Demographic and clinical data were obtained from the registry as well as in-hospital mortality. CT scans were blindly reviewed to assess the occurrence of hemorrhagic transformation. Among acute stroke patients who received IV TPA, we compared those with and without a positive serology for CD.
  
  
  RESULTS
  Among 240 patients treated with IV TPA, 174 had serologic testing for CD available. Of those, 24 patients (13.8%) had positive serology for CD. Patients with CD more frequently had heart failure (45.8% vs 14.7%; p < 0.01) and higher admission NIH Stroke Scale scores (19 [15-21] vs 13 [8-19]; p < 0.01) than patients with negative serology. The rates of SIH (4.2% vs 5.3%; odds ratio: 0.77; 95% confidence interval: 0.09-6.46; p = 0.99) and in-hospital death (16.7% vs 11.3%; odds ratio: 1.57; 95% confidence interval: 0.48-5.12; p = 0.50) were not higher among patients with CD.
  
  
  CONCLUSIONS
  In the largest published series of patients with CD-related stroke treated with IV TPA, we have observed that IV thrombolysis was safely performed and showed no increase of SIH. The diagnosis of CD should not preclude IV thrombolysis in these patients.
authors.affiliation: From the Ribeirão Preto School of Medicine, University of Sao Paulo, Ribeirão Preto, Brazil.
authors.forename: Pedro Telles
authors.initials: PT
authors.lastname: Cougo-Pinto
authors.forename: Bruno Lopes
authors.initials: BL
authors.lastname: Dos Santos
authors.forename: Francisco Antunes
authors.initials: FA
authors.lastname: Dias
authors.forename: Millene Rodrigues
authors.initials: MR
authors.lastname: Camilo
authors.forename: Frederico Fernandes
authors.initials: FF
authors.lastname: Alessio-Alves
authors.forename: Clara Monteiro Antunes
authors.initials: CM
authors.lastname: Barreira
authors.forename: Taíza Elaine Grespan
authors.initials: TE
authors.lastname: Santos-Pontelli
authors.forename: Daniel Giansante
authors.initials: DG
authors.lastname: Abud
authors.forename: João Pereira
authors.initials: JP
authors.lastname: Leite
authors.forename: Octavio Marques
authors.initials: OM
authors.lastname: Pontes-Neto
mesh_terms: D000368:Aged; D014355:Chagas Disease / Q000097:blood / Q000150:complications*; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006333:Heart Failure / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator